diagnosis and cure of mental disorders in children Early...

Early psychotherapeutic intervention for the prevention, diagnosis and cure of mental disorders in children

More than 20 years of research

✓ we would like to present the research

started by Dr. Adriana Bembina, the mind

and heart guiding this research group, that

has been working on children mental health

for more than 20 years

Dr. Adriana Bembina

More than 20 years of research

she worked as a speech therapist in a public service for infant and maternal

rehabilitation, while still being a psychodynamic psychotherapist

she noticed that:

✓ the rehabilitation produced modest results

✓ the initial symptoms were replaced by other symptoms/comorbidities

✓ a high percentage of these children showed different psychiatric

disorders during adolescence/adulthood

medical training led her to realize that the etiopathogenesis of these

disorders was only hypothesized… the possibility of a cure was in fact

highly improbable

Dr. Adriana Bembina

Psychoactive drugs

✓ their use became progressively more frequent in children when

cognitive behavioral therapy gave limited results

✓ they can only ease the symptoms

✓ they can cause heavy side-effects and the risk of irreversibly damaging,

overtime, a person who has yet to fully develop

Dr. Adriana Bembina

Dr. Adriana Bembina

Adriana Bembina’s research

The origin: the therapy, training and research started at the end of the

1970s through the Collective Analysis of the psychiatrist Massimo Fagioli

The research: the focus of the research for the cause of children mental

disorders shifted from the child to the parents, who often did not present

any obvious psychiatric disorders… we focused our research on the

non-conscious dimensions

The current situation: the fact that the parents did not present any

obvious pathological behavior may have supported the hypothesis of an

epigenetic transmission or of some other hereditary factor

Mother-child relationship

Massimo Fagioli’s Human Birth Theory

✓ from the Enfant Recherche onwards, we know that the relationship of

children with their mothers is essential for their healthy development

✓ studies on Attachment have confirmed the importance of this

relationship in children’s development

› Fagioli’s theory allowed us to deepen our research beyond the visible

behavior of the parents, and gave us the opportunity to identify the

pulsional dynamics acted through non-conscious images

Massimo Fagioli’s Human Birth Theory

✓ birth is both healthy and equal for all human beings

✓ mind and body become fused together at the moment of birth

✓ human mind appears at birth as a result of a reaction of the brain

tissue (retina) to the light

✓ fetus is immersed in the amniotic fluid, in the darkness of the uterus,

up until the moment of birth, when the retina is exposed for the first

time to light

Human Birth Theory

Newborns, in reaction to light:

✓ close their eyes

✓ consider as non-existent (the annulment pulsion) the elements of the

world that could kill them, such as the cold but mainly the light

✓ realize a memory of their previous experience of the homeostasis of

the amniotic fluid on their skin (the disappearance fantasy)

Human Birth Theory

In this way…

✓ the annulment pulsion is fused with the emergence of the newborns’

vitality and capability to imagine

✓ their first way of thinking, is as images, a way of thinking that, as

adults, will come back as dreams

✓ newborns, thanks to the vitality that emerges at birth, realize the

certainty/hope that a breast exists

Human Birth Theory

Human relationships

✓ in their relationship with another human being, newborns will have

the confirmation, or not, of this hope

✓ with every confirmation, their vitality will increase, together with the

certainty of themselves and their ability to go forward through the

stages of their development

Human Birth Theory

Separation

✓ birth can be considered the first separation between children and their

parents

✓ during the course of his growth children will have to face other

moments of separation

✓ these separations will challenge their vitality and the certainties they

acquired, to make their current self disappear, and allow for a new self

to appear

Human Birth Theory

Separation

✓ it is essential that adults recognize and accept their children’s constant

development, allowing them to grow and continue this separation

✓ the emotions of an adult negating or annulling the identity of a child

are invisible

Emotions manifest themselves:

› in pathological relational dynamics

› the symptoms of children who reach us with a diagnosis of

neurodevelopmental disorders

Human Birth Theory

What is the annulment pulsion?

✓ it is the most invisible and dangerous dimension, especially for children

✓ it is very similar to the calmness that parents need when dealing with

the upsetting event of their children’s birth

› their children’s birth can throw parents into an unknown reality… this

may challenge their self-consciousness and confidence, as they must

face the complexity of satisfying the continuous requests of their

children for a valid relationship

Human Birth Theory

The annulment pulsion

✓ the calmness from one’s own identity can be confused with the

calmness that allows parents to care for their children efficiently, but

in spite of their emotional presence

✓ the sensitivity of children is a richness within human relationships, but

it can turn into a vulnerability when the emotions from their parents

are not adequate

Human Birth Theory

What is negation (non-conscious denial)?

✓ it is the dimension that often affects children’s growth, as parents see

them as less “grown up” than what their age would allow

What is yearning?

✓ it causes parents to engulf their children, in a useless attempt to

compensate for their own internal void

Human Birth Theory

Our research

✓ for each one of these dimensions we were able to detect a prevalent

correspondence between their presence and the symptoms showed by

the children

› from the milder, and apparently transitory, disorders: secondary

enuresis and encopresis…

› to the more severe and persistent: ADHD, mood disorders,

oppositional defiant, conduct, or obsessive-compulsive disorder, and

tic and Tourette syndrome

Our research

How we work

✓ two different psychotherapists work one with each parent

✓ the third psychotherapist sometimes works with the child

This choice depends on three main aspects

✓ the specific disorder affecting the child

✓ the ability of both parents to understand the indications and

interpretations

✓ the ability of both parents to report in a precise way their child’s

improvements

Our research

How we work

Some parents

✓ are aware that the symptoms of their children are a consequence of

their parenting behavior, that we define as the expression of the

images and non-conscious actions they transmit to the child

✓ need a different setting, as they show a stronger opposition toward

accepting this new interpretation of their situation

› In these cases, a dedicated activity with the child is needed to support

them while waiting for their parents to change

Our research

How we work

✓ seeing a rapid improvement in the symptoms of their children,

motivate parents to continue their psychotherapy to understand their

non-conscious reality, and realize a deeper and longer lasting change

in their parental relationship…

✓ a continuous exchange of information among the psychotherapists is

essential to make the treatment successful

✓ this type of setting is a break from the norm

Our research

PDM 2

✓ it states that we have luckily left behind the time in which parents

were regularly blamed for the emotional and behavioral issues of their

children

Our approach

✓ we think that this exoneration could actually risk dooming parents to

almost helplessly witnessing their children suffer from disorders that

often last an entire lifetime

✓ if parents can learn the cause of their children’s symptoms, and not

been held guilty for them, their ability of changing is enhanced

PDM 2

How we work

several studies related mental disorders in mothers with subsequent

mental issues in their children

but…

› the parents we are referring to usually do not show any clinically

evident mental disorders

thus…

› psychotherapy aims at transforming the non-conscious images that

parents experience, and to which children respond with specific

symptoms

✓ the rapid resolution of children’s symptoms allows parents to discover

and overcome the critical aspects of their non-conscious relationship

with their children

Our research

Results

✓ The percentage of successful cases in our clinical experience is very

high, as the parents that seek our help often already have a

background experience on what they are going to face

How do they reach us?

✓ pediatricians or other psychotherapists, often with our same reference

theory, refer them to us

✓ they have doubts on the pharmacological treatment prescribed to

their children after a diagnosis or after a therapy that gave no

significant results

Our research

How do we confirm results?

› the confirmation of the permanent remission of all symptoms was

obtained thanks to keeping in contact with:

✓ parents

✓ schools

✓ children themselves, who, once reaching adolescence or young

adulthood, can get in touch with us for a consultation

in this type of population, the percentage of permanent remission of

symptoms and complete cure is very high

› the prognosis is negative when parents discontinue the psychotherapy

this is confirmed by the fact that their children, as adults, seek our help

showing a set of symptoms which are coherent with their first

diagnosis

Our research

Thank you

http://www.laparolaaibambini.it/

Clinical Cases

Clinical Cases

The disorders we want to discuss here are:

✓ Developmental Coordination Disorders

and Speech Sound Disorders (DCD, SSD)

✓ Attention Deficit and Hyperactivity

Disorder (ADHD)

✓ Tic and Tourette Syndrome (TTS)

Clinical Cases

✓ Developmental Coordination Disorders

and Speech Sound Disorders (DCD, SSD)

Clinical Cases: DCD, SSD

Developmental Coordination Disorder

✓ children are diagnosed with a DCD when they do not reach the motor

skills required for their age, such as…

buttoning up a shirt, climbing down a stair, riding a bike, solving a

puzzle, using scissors


Reading the DSM-5…

✓ these children do not present any detectable organic damage

✓ environmental factors hypothesized as etiopathogenetic are unspecific

and can only be reconstructed ex post based on the symptoms

observed


What is the etiology?

neonatal and pediatric checkups are currently extremely accurate, thus it

is highly improbable that no issue is detected

✓ most of the authors: they find a confirmation of the genetic basis of

these disorders in the significantly higher prevalence in males, ranging

from a 2:1 proportion to a 7:1 proportion (DSM-5)

✓ we: our research is based on a simple observation, every male child is

born to a female mother, who is the person most involved in his first

and most vulnerable years

✓ a male-female relationship: non-conscious dynamics affecting the

boy’s growth are much easier to develop


Non-conscious dynamics

✓ any psychopathological hypothesis has for a long time been banned as

non-scientific

✓ our clinical experience confirm that unknowingly mothers can develop

negations and annulments specifically against his gender identity


Definition

✓ children with dyspraxia appear as younger than their age, but

obviously not in their physical appearance, that is fully normal

✓ this definition may appear too concise and imprecise, but it is aimed at

shifting the attention on the cause of this apparent stop in the

development of motor skills


Parental relationship

✓ physical development (weight and height) and motor development

(walking and gross motor skills of the first year of life) in normal

conditions are not affected by the relationship with parents

✓ fine motor skills can be heavily influenced by the family environment

✓ the families of the children we treat do not show any evident

behavioral anomalies

✓ usually the disorder is identified in the child, and not in the

relationship between the child and the significant adult


Biological characteristics of human beings

✓ standing position

✓ opposing thumb

✓ fine motor skills (language and the ability to write)

Children living naturally with other human beings will spontaneously

acquire these abilities without them being thought by their mothers


Children desire to grow up

✓ children want to grow up in order to be able to do all those things that

adults know and can do

✓ children prefer to play with real objects… keys, glasses, phones and

not the toy version

✓ children want to be able to live the lives of the adults that they admire

and love


Are children “allowed” to grow up?

The relationships that make children clumsy or dyspraxic are those that

severely slow down their normal drive to grow up

✓ buttoning a shirt, tying shoes means to grow up and become a bigger

boy or girl

✓ if they are not allowed to grow up… they accept an internal image of

themselves less-developedIf they love me as a

small child, how can

they love me if

I grow up


Our clinical experience

✓ the dysfunctional relationships that cause these slowdowns can be

cured in an easier and faster way when compared to other disorders

Mothers

✓ do not show severe psychological disorders

✓ are often able to give up the image they have of their children as small,

once lead to understand the damage that they are non-consciously

inflicting on them


Speech Sound Disorder

✓ children with a diagnosis of SDS keep on using immature processes of

phonetic simplification even if they are beyond the age in which the

majority of children are able to clearly produce words


Testing children

✓ the neuropsychological tests are not as objective as laboratory/

instrumental tests, whose results are independent from the

cooperation of the examined subject

✓ when testing children’s abilities we can only assess what they show us

with their behavior, and not what they are actually capable of doing!



✓ children exposed to a normal linguistic environment will be able to

learn a language to a level at least sufficient for a typical daily

conversation

✓ children do not want to show their abilities to their parents nor to

other adults



✓ children: for them, speaking correctly is the realization and proof of

their development and growth… it means becoming more

autonomous from their parents

✓ parents: they do not always positively experience their children’s

growth… they easily admit that they are more able to feel and show

affection, love and warmth when their children are less grown up


Temporary slowdown

✓ children require an enormous, but physiological, amount of work to

acquire language

✓ children could happen not to be motivated to confront this challenge

✓ this could cause a temporary slowdown, even though our clinical

experience does not confirm it


Temporary slowdown

✓ this happens when this advancement in linguistic ability does not come

together with an increase in the consideration, recognition and

affection by their parents

✓ this happens when parents are only able to maintain an adequate level

of affection towards their children by negating their growth


Testing children

✓ what children show us, thus what determines the diagnosis, is only

what they can show us while experiencing a troubled family

relationship, which is very often hard to identify


Our therapeutic intervention

✓ we aim at curing those relationships that determine the disease, with

the objective of removing what we can define as the pathogen that

causes the alteration in the behavior of the child


Our therapeutic intervention

✓ we do not rehabilitate nor habilitate children

✓ we do not teach children with a disorder what they were not able to

learn by themselves

✓ we remove what prevents them from having a normal development

No mental structure or function was disrupted… all was just an alteration of

the normal expression of a specific ability…

what “disappeared”, can also “reappear”


A clinical case of DCD and SSD


Tommaso

✓ he is 5 years old and has a diagnosis of dyspraxia and dyslalia

✓ he kept on replacing the vowel “o” with the vowel “a”... “trophy” won in

a competition turned into a “traphy”

✓ his language was unintelligible, and he seemed to be unable to solve a

puzzle meant for 3-years-old children

His mother

✓ she was negating the development of this son and treating him as if he

was much younger than his actual age

✓ she was trying to compensate for the time she had spent with the older

son who now recovered from several surgeries


please, speak properly!

Can you close the door...?

sure!

Thank you! I didn’t want my

dad and mom to hear us…


It’s really weird that you’re not

able to complete that now that it

was so much easier!


Comorbidity or just a common etiology?

✓ comorbidity: concomitant presence in one single subject of different

conditions each due to a different cause

✓ common etiology: we believe a common etiology can be identified, in

this case, the mother negating the normal development of her child,

causing both CDC and SSD


Delay or, better, slowdown?

these disorders, in which no organic cause can be identified, could be

better defined as “slowdowns” and not as “delays”

› these children can completely recover the slowdown, which is

functional and reversible


To better understand the essential difference between a diagnosis of “delay” and a

diagnosis of “slowdown”:

these children behave as a train than has to slow down for a short time due to an

impediment on the line, let’s say some rocks that fell on the rails…

… but then, once the obstacle is removed, the train can start back, recover all the

time it had lost, and still make it in time as the engine did not have any damage

Clinical Cases

✓ Attention Deficit and Hyperactivity Disorder

(ADHD)

Clinical Cases: ADHD

Diagnostic criteria

main characteristics associated with a diagnosis of ADHD:

✓ impulsivity

✓ inattention

✓ hyperactivity


Human Birth Theory

every child experiences the physiological need for human relationships

which are as essential for him/her exactly as warmth and food

This is what a newborn child experiences at the moment of birth:

› the capability to imagine the existence of another human being, who is

able to reciprocate his/her desire


All children

✓ need to be perceived and “seen” by their parents, understood and

protected mainly from aggressive human relationships

✓ have, since their birth, an extraordinary sensitivity that makes them

much more vulnerable to invisible aggressions

✓ show some sort of distress probably when this sensitivity is even

deeper


What do annulment pulsion and negation do?

✓ wear down children’s vitality

✓ weaken children’s still fragile identity

✓ damage the image of coherence and wisdom children have of

adulthood


What do children with ADHD experience and feel?

They:

✓ perceive a constant feeling of anxiety

✓ move constantly

✓ are unable to focus and carry out an activity for the time required for

its completion

✓ are restless as if they were the only ones perceiving an imminent

invisible, but serious danger

✓ move around anxiously and aimlessly


… and why do they experience that?

this is how they react to situations they feel as threatening and

overpowering, as they perceive themselves as helpless spectators, with an

annulment pulsion against frustrating and disheartening human

relationships


… and why do they experience that?

when experiencing moments of mental void, of absence of relationship

with another human being… they feel as non-existent, as if they

disappeared… thus they need hyperactivity to feel as non-absent


… they want to be seen

these children

✓ are scared of being “invisible”

✓ do whatever is in their power, to be “seen” by everyone, but mainly by

themselves

✓ act as “bad” because they believe they are actually bad

✓ make “disappear” who they perceive as frustrating and disheartening,

when in fact they are making themselves “disappear”

their mothers

✓ alternate unemotional reactions with moments of emotional presence


A clinical case of ADHD


Mario

✓ a 6-years-old child with a diagnosis of ADHD was in treatment with

Ritalin since a couple of months, but side effects were overwhelming:

sleepiness, apathy, inappetence


His mother

✓ separated from her husband who had not met his son in months

✓ acts an annulment pulsion against the rage she feels toward her child

✓ suffered and was angry, but tried not to show these feeling by “turning

into stone”

Results

› the mother learned how to separate from this upsetting feelings, and

the child became more calm and cooperative

› we gradually tapered pharmacological treatment until discontinuation

Clinical Cases

✓ Tic and Tourette Syndrome (TTS)

Clinical Cases: TTS

According to the European Guidelines

tics are:

✓ sudden, rapid, recurrent, non-rhythmic movements or sounds that

usually manifest in bouts

they:

✓ have a non-constant trend in terms of frequency, intensity, type of tic

✓ onset, in children, is typically at 5 to 6 years of age

› Tourette syndrome includes the combination of chronic motor and

sound tics

Clinical Cases: TTS

What is TTS?

is the expression of children failing to attempt to control their deep rage

towards their parents who try to cage them in an educational scheme too

strict for their original and lively personalities

Clinical Cases: TTS

Parents strictness

✓ shows an insecurity and immature personality

✓ shows identification with their own parents

› often we found an obsessive-type personality in these parents

› this does not mean that the disorder in children is due to a genetic

inheritance, but it is instead due to a relationship acted by their

parents in an obsessive way

Children

✓ they feel that something is strange, distorted… but they annul their

rage and try to obey

✓ their mental images of humiliation and hatred towards their parents

unexpectedly emerge

✓ they get to make these images disappear with the help of a gesture…

and then a sound

Clinical Cases: TTS

Treatment

› if the obsessive structure of the “responsible” parents is not too heavy,

they will be able to stop transferring the rituals in their children,

sometimes delegating to the other parent the activities in which the

rituals are more focused

Clinical Cases: TTS

A clinical case of TTS

Clinical Cases: TTS

Lia

✓ she is 7 years old

✓ she has a persistent cough

✓ she is always “dressed up” nicely

✓ she blinks her eyes and feels more calm

Her father

✓ takes care of Lia’s appearance in an excessive way, even changing her

clothes several times during the same day

Clinical Cases: TTS

Clinical Cases: TTS

Treatment

both parents started psychotherapy separately:

✓ the father after some time started allowing Lia to dress for herself

✓ the mother stopped giving up her role in the family due to her lack of

self-consciousness

all symptoms disappeared in a short time

Clinical Cases

Conclusions and future perspectives

Conclusions

Conclusions

› based on a series of solved and cured cases, we identified the common

elements that we believe are the cause of some mental disorders in

children

› a treatment that modifies the pathological aspects of the relationship

achieve a complete remission of all symptoms, even several years after

the treatment

Future perspectives

Future perspectives

› we believe that this could be a new way of thinking children mental

health, widening the research in this field

› focusing the research on human relationships, which means a healthy

birth and a healthy development with no annulment pulsion, negation

and yearning, instead of focusing it on organic causes could lead to

new possibilities of curing mental disorders in these little patients and

their families

Thank you

http://www.laparolaaibambini.it/

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